Study of the utility of blood culture in febrile children aged between 3 months to 12 years admitted in a tertiary centre


  • Zosangliani . Department of Pediatrics, RIMS Hospital, Houston, Imphal, Manipur, India
  • Rukuwe Thele Department of Pediatrics, RIMS Hospital, Houston, Imphal, Manipur, India
  • Manisha Sharma Department of Pediatrics, RIMS Hospital, Houston, Imphal, Manipur, India
  • Niranjana S. Department of Pediatrics, RIMS Hospital, Houston, Imphal, Manipur, India
  • T. Kambiakdik Department of Pediatrics, RIMS Hospital, Houston, Imphal, Manipur, India



Antibiogram, Bacteraemia, Blood culture, Blood stream, Infections fever with localising signs


Background: Fever, the most common complaint that led patients to seek healthcare, indicates an underlying infection which could either be simple self-limiting viral infections or life threatening bacterial infections. It’s greatest challenge is the risk of occult bacteraemia, for which blood culture is the gold standard for the diagnosis. Objectives was to determine the proportion of blood culture positives among febrile children and to describe the bacteriological profile and antibiogram of blood culture isolates.

Methods: A cross sectional study was done in the Department of Paediatrics and Microbiology, RIMS Hospital, Imphal. After obtaining consent (verbal assent in >7 years), blood culture samples were drawn from 200 children aged between 3 months to 12 years. The data was analysed using descriptive statistics. Chi square test was used and p-value of less than 0.05 taken as statistically significant.

Results: Culture positivity was seen in 17 cases (8.5%) of which, participants who were less than 1 year of age and without proper immunisation record showed the highest positivity rate. It was higher in fever with localizing signs (9.2%) than those with fever without focus (7.8%). Gram positives constituted 11 (64.7%) of the isolates while 35.3% were Gram negatives. Staphylococcus aureus was the only Gram positive isolate. Of them, 4 were MRSA but all the strains were sensitive to Vancomycin and Linezolid. The most common Gram negative isolate was Acinetobacter spp and 80% of them were sensitive to Aminoglycosides while most of the Gram negatives were resistant to Ampicillin and 3rd generation Cephalosporins. All Acinetobacter spp were sensitive to Carbapenems but the only Pseudomonas spp isolated was sensitive only to Colistin.

Conclusions: Blood culture positivity rate is relatively low in this study. However, studies with larger sample sizes are recommended to validate the findings. We emphasise the need for antibiotic stewardship


Linda S, Kamat D, Nield. Fever. In: Kleigman RM, Behrman RE, Jeon HB, Stanton BF, editors. Nelson textbook of Pediatrics. 19th ed. New Delhi: Elsevier Inc;2011:1277-1279.

Shah SS, Alpern ER, Zwerling L. Risk of bacteremia in young children with pneumonia treated as outpatient. Arch Pediatr adolesc Med. 2003;157(4):389-92.

Arora U, Devi P. Bacterial profile of blood stream infections and antibiotic resistant pattern of isolates. JK Sci. 2007;9(4):186-90.

Sharma M, Goel N, Chaudhary U, Aggarwal R, Arora DR. Bacteraemia in children. Indian J Pediatr. 2002;69(12):1029-32.

Msafiri CL, Lilunguru A, Kimaro F, Ng'weshemi CK. Bacteraemia among febrile under five children at Makole health centre Dodoma Tanzania. Acta Scientific Paediatri. 2019;(1):2-7.

Vaghela HG, Duttaroy B, Prajapatti KC. Bacteriological profile and antibiogram of blood culture isolates from paediatric patients with special reference to ESBL and MRSA in a tertiary care centre. Indian J Microbiol Res. 2019;6(3):261-5.

Salamah KM, Awean GZ, Alkume N, Abdussalam Shah AK. The outcome of blood cultures in febrile children presenting at the Emergency Department. Neonat Pediatr Med. 2016;2(2):117.

McGowen JE, Bratton L, Klein JL, Finland M. Bacteremia in febrile children seen in a walk in pediatric clinic. N Engl J Med 1973;288:1309-12.

Kumar YG, Udayamaliny A, Ankitha S. Blood culture and bacteremia predictors in infants less than 1 year with fever without focus. J Evolut Med Dent Sci. 2015;4(66):11432-9.

Tiwari DK, Golia S, Sangeetha KT, Vasudha CL. A study on the bacteriological profile and antibiogram of bacteremia in children below 10 years in a tertiary care hospital in Bangalore, India. Journal of clinical and diagnostic research: JCDR. 2013 Dec;7(12):2732.

Eshwara VK, Munim F, Tellapragada C, Kamath A, Varma M, Lewis LE, et al. Staphylococcus aureus bacteremia in an Indian tertiary care hospital: observational study on clinical epidemiology, resistance characteristics, and carriage of the Panton–Valentine leukocidin gene. Int J Infect Dis. 2013 Nov 1;17(11):e1051-5.

Greenhow TL, Hung YY, Herz A. Bacteremia in children 3 to 36 months old after introduction of conjugated pneumococcal vaccine. Pediatr. 2017;139(4):e20162098

Murillo TA, Beavers-May TK, English D, Plummer V, Stovall SH. Reducing contamination of peripheral blood cultures in a pediatric emergency department. Pediatr Emerg Care. 2011;27(10):918-21.

Huang N, Morlock L, Lee CH, Chen LS, Chou YJ. Antibiotic prescribing for children with nasopharyngitis (common colds), upper respiratory infections, and bronchitis who have health-professional parents. Pediatr. 2005;116(4):826-32.

Avner JR, Baker MD. Occult bacteremia in the post-pneumococcal conjugate vaccine era: does the blood culture stop here. Acad Emerg Med. 2009;16(3):258-60.

Gille JP, Hansson KE, Gardlund B. Clinical and laboratory variables identifying bacterial infection and bacteraemia in the emergency department. Scand J Infect Dis. 2012;44(10):745-52.

Brockmann VP, Ibarra GX, Silva WI, Hirsch BT. Etiology of acute fever without source in infants consulting at an emergency department. Rev Chilena Infectol. 2007;24(1):33-9.

Baraff LJ, Lee SI. Fever without source: management of children 3 to 36 months of age. Pediatr Infect Dis J. 1992;11(2):146-51.

Bressan S, Berlese P, Mion T, Masiero S, Cavallaro A. Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review. Acta Paediatr. 2012;101(3):271-7.






Original Research Articles